title: Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: first 250 cases.
abstract: BACKGROUND
  A growing body of evidence supports the laparoscopic sleeve gastrectomy (LSG) as a safe and effective procedure for sustained weight loss and amelioration of weight-related co-morbidities. Procedures performed in ambulatory surgery centers (ASC) can provide several advantages over hospital-based surgery. We present our results of 250 consecutive patients undergoing LSG in an ASC. The objective of this study was to assess the safety and efficacy of outpatient LSG in a freestanding ASC.
  
  
  METHODS
  Data was collected prospectively from 250 consecutive patients who underwent LSG at a freestanding ASC. Patients were excluded from the ASC if they weighed>450 pounds, if anticipated operative time was>2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours. Revisions were not included in this study.
  
  
  RESULTS
  Mean age was 47 years (range, 23-74 yr). Mean preoperative body mass index (BMI) was 43 kg/m² (29-71 kg/m²). Mean operative time was 60 minutes (31-161 min). Mean recovery room time was 131 minutes (30-385 min). Mean percent excess weight loss (%EWL) was 60% at 1 year and 63% at 2 years. Nine patients (3.6%) were readmitted within 30 days. Two patients (.8%) were transferred from the ASC to a hospital. There was 1 staple line leak (.4%). There were no open conversions and no deaths.
  
  
  CONCLUSIONS
  LSG can be performed safely in a freestanding ASC in select patients with outcomes comparable to the inpatient standard. Additional studies are needed to formulate selection criteria and guidelines to maximize patient safety and outcomes.
authors.affiliation: Puget Sound Surgical Center, Edmonds, Washington. Electronic address: pbilling@pssurgicalcenter.com.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Billing
authors.affiliation: Puget Sound Surgical Center, Edmonds, Washington.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Crouthamel
authors.affiliation: Puget Sound Surgical Center, Edmonds, Washington.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Oling
authors.affiliation: Puget Sound Surgical Center, Edmonds, Washington.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Landerholm
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D055815:Young Adult
keywords: Ambulatory surgery; Bariatric surgery; Obesity; Outpatient surgery; Sleeve gastrectomy